Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19 / Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic

Objetivo:Evaluar si la aparición de una situación de crisis como la que ha supuesto la pandemia por el SARS-CoV-2, junto a los cambios organizativos adoptados en Atención Primaria, han influido en la implementación de actividades preventivas cardiovasculares en pacientes de 40 a 74 años. Diseño: Estudio descriptivo multicéntrico retrospectivo durante tres años (2019-2022) en Atención Primaria.Ámbito: 35 centros de salud de Atención Primaria de la Dirección Asistencial Norte de Madrid. Participantes: Se incluyeron 1.008 pacientes de ambos sexos entre 40 y 74 años con diagnósticos de hipertensión, diabetes mellitus y/o dislipemia. Método: Se recogen a partir de la historia clínica informatizada las siguientes variables: actividades preventivas sobre el estilo de vida (consumo de tabaco, alcohol, consumo de dieta mediterránea y práctica de ejercicio) considerando óptimo tres de los cuatro parámetros; datos de exploración (registro de tensión arterial) y registro de analítica (glucemia, HbA1c, colesterol total, HDL, LDL) considerando óptimo cuatro de los cinco parámetros. Se analizan diferencias entre tiempo de prepandemia (15/03/2019-14/03/2020), pandemia (15/03/2020-14/03/2021) y transición (15/03/2021-14/03/2022). Análisis estadístico: Prueba de McNemar para comparar las variables principales entre los periodos de estudio. Resultados: Se recogen datos de 1.008 pacientes. El registro de actividades preventivas sobre el estilo de vida fue de 180 pacientes (17,9%) (IC 95%: 0,155-0,204) en prepandemia, 29 pacientes (2,9%) (IC 95%: 0,019-0,041) en pandemia y 55 pacientes (5,5%) (IC 95%: 0,041-0,070) en la etapa de transición (p < 0,05). La exploración estaba registrada en 393 pacientes (39%) (IC 95%: 0,360-0,421) en la prepandemia, 133 pacientes (13,2%) (IC 95%: 0,112-0,154) en pandemia y en 218 pacientes (21,6%) (IC 95%: 0,191-0,243) en la transición (p < 0,05).(AU)

Objective:To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. Design: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. Setting: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. Participants: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. Method: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). Statistical analysis: MC Nemar's test to compare the main variables between the study periods. Results: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05).(AU)

[Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]. / Prevención cardiovascular en Atención Primaria en situación de crisis: estudio comparativo multicéntrico antes, durante y después de la pandemia por SARS-COVID-19.

OBJECTIVE: To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. DESIGN: Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. SETTING: 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. PARTICIPANTS: 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. METHOD: The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). STATISTICAL ANALYSIS: MC Nemar's test to compare the main variables between the study periods. RESULTS: Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05). CONCLUSIONS: Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.

Finerenone protects against progression of kidney and cardiovascular damage in a model of type 1 diabetes through modulation of proinflammatory and osteogenic factors.

The non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone (FIN) improves kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) in type 2 diabetes (T2D). We explored the effect of FIN in a novel model of type 1 diabetic Munich Wistar Frömter (MWF) rat (D) induced by injection of streptozotocin (15 mg/kg) and additional exposure to a high-fat/high-sucrose diet. Oral treatment with FIN (10 mg/kg/day in rat chow) in diabetic animals (D-FIN) was compared to a group of D rats receiving no treatment and a group of non-diabetic untreated MWF rats (C) (n = 7-10 animals per group). After 6 weeks, D and D-FIN exhibited significantly elevated blood glucose levels (271.7 ± 67.1 mg/dl and 266.3 ± 46.8 mg/dl) as compared to C (110.3 ± 4.4 mg/dl; p < 0.05). D showed a 10-fold increase of kidney damage markers Kim-1 and Ngal which was significantly suppressed in D-FIN. Blood pressure, pulse wave velocity (PWV) and arterial collagen deposition were lower in D-FIN, associated to an improvement in endothelial function due to a reduction in pro-contractile prostaglandins, as well as reactive oxygen species (ROS) and inflammatory cytokines (IL-1, IL-6, TNFα and TGFß) in perivascular and perirenal adipose tissue (PVAT and PRAT, respectively). In addition, FIN restored the imbalance observed in CKD between the procalcifying BMP-2 and the nephroprotective BMP-7 in plasma, kidney, PVAT, and PRAT. Our data show that treatment with FIN improves kidney and vascular damage in a new rat model of DKD with T1D associated with a reduction in inflammation, fibrosis and osteogenic factors independently from changes in glucose homeostasis.

Evidence of Covid-19 lockdown effects on riverine dissolved organic matter dynamics provides a proof-of-concept for needed regulations of anthropogenic emissions.

The fast spread of SARS-CoV-2 virus in Italy resulted in a 3-months lockdown of the entire country. During this period, the effect of the relieved anthropogenic activities on the environment was plainly clear all over the country. Herein, we provide the first evidence of the lockdown effects on riverine dissolved organic matter (DOM) dynamics. The strong reduction in anthropogenic activities resulted in a marked decrease in dissolved organic carbon (DOC) concentration in the Arno River (-44%) and the coastal area affected by its input (-15%), compared to previous conditions. The DOM optical properties (absorption and fluorescence) showed a change in its quality, with a shift toward smaller and less aromatic molecules during the lockdown. The reduced human activity and the consequent change in DOM dynamics affected the abundance and annual dynamics of heterotrophic prokaryotes. The results of this study highlight the extent to which DOM dynamics in small rivers is affected by secondary and tertiary human activities as well as the quite short time scales to return to the impacted conditions. Our work also supports the importance of long-term research to disentangle the effects of casual events from the natural variability.

[Attending COVID-19 patients during the first wave of the pandemic in a Medium Stay Hospital: Variables associated with mortality in hospitalized patients in an acute situation]. / Atención a pacientes COVID-19 durante la primera ola de la pandemia en un hospital de media estancia. Variables asociadas con mortalidad en ingresados en situación aguda.

BACKGROUND AND OBJECTIVE: Spain has been one of the countries most affected by the SARS-CoV-2 pandemic. The objective of this study is to describe the characteristics of the patients treated for COVID-19 at Guadarrama Hospital and to identify the associated mortality factors in those admitted in an acute situation. MATERIAL AND METHODS: Retrospective observational study of COVID-19 patients admitted from 3/15 to 5/15/2020. Sociodemographic, mental, functional, analytical, clinical, radiological and therapeutic variables were collected. Factors associated with mortality were analysed using a bivariate and multivariate study. RESULTS: Two hundred eleven patients were included: 102 (48.3%) in an acute situation and 109 (51.7%) in the convalescent phase, the median (interquartile range) age was 82 (72, 85) years. The most frequent symptoms were fever, cough and respiratory failure. The 89.9% had pneumonia. An acute mortality rate of 26.5% (27/102) was detected and the associated factors were: respiratory failure (P 0.002), Charlson index (ChI)≥3 (P<0.001), CURB≥2 (P 0.011), low SatO2/FiO2 ratio (<0.001), elevated urea (P<0.001) and creatinine (P 0.036), hypoproteinemia (P 0.037) and age (P<0.018). The deceased had a worse functional situation than the survivors (P 0.025). In the multivariate analysis, SatO2/FiO2 ratio (OR: 2.23; 95% CI: 1.07-4.63; P 0.031) and ChI≥3 (OR: 4.25; 95% CI: 1.06-17.04; P 0.041) were independent factors of mortality. CONCLUSIONS: The COVID-19 patients treated were mostly severe cases. The variables associated with mortality were age, respiratory failure, comorbidity, kidney failure, and malnutrition. Respiratory failure and comorbidity outweigh age as independent risk factors for mortality.

[Evaluation of adherence to treatment with calcium and vitamin D in the elderly in a basic health area]. / Evaluación de la adherencia al tratamiento con calcio y vitaminaD en ancianos de una zona básica de salud.

BACKGROUND AND OBJECTIVE: The vitamin D deficiency is high in the elderly population. Calcium and vitamin D supplements is a frequently used measure in individuals at risk for falls and/or fractures. However, this practice has achieved a low level of compliance. The aim is to assess the adherence to treatment with calcium and vitamin D in elders with hypovitaminosis D in an urban area of Madrid. PATIENTS AND METHODS: Intervention study performed on 438 individuals ≥65years from the 'Peñagrande Cohort' with hypovitaminosis D that were treated with calcium and vitamin D. Adherence at 3 and 12 months was assessed using the Morisky-Green and counting of prescriptions written. RESULTS: A total of 413 of the 438 individuals with hypovitaminosis D were analysed (18 patients were not treated because of contraindications, and 7 were considered lost). At 3 and 12 months, 63.9% and 47.2%, respectively, were adherents. After a brief educational intervention, 19.3% of individuals without adherence at 3 months became good compliers when measured at one year. Comorbidity was associated with lower rates of adherence to treatment after one year (46.3% versus 35.2%, P=.027). The main cause of non-adherence to calcium was digestive intolerance, and due to oversights for vitamin D. Concordance between adherence assessed by the Morisky test and counting of prescriptions written was high (Kappa index=69.8%). CONCLUSIONS: Non-adherence to chronic treatment with calcium and vitamin D is a relevant problem in elderly. It is important to assess adherence and implement health education strategies in clinical practice.

Strategy for design NIR calibration sets based on process spectrum and model space: An innovative approach for process analytical technology.

The pharmaceutical industry is under stringent regulations on quality control of their products because is critical for both, productive process and consumer safety. According to the framework of "process analytical technology" (PAT), a complete understanding of the process and a stepwise monitoring of manufacturing are required. Near infrared spectroscopy (NIRS) combined with chemometrics have lately performed efficient, useful and robust for pharmaceutical analysis. One crucial step in developing effective NIRS-based methodologies is selecting an appropriate calibration set to construct models affording accurate predictions. In this work, we developed calibration models for a pharmaceutical formulation during its three manufacturing stages: blending, compaction and coating. A novel methodology is proposed for selecting the calibration set -"process spectrum"-, into which physical changes in the samples at each stage are algebraically incorporated. Also, we established a "model space" defined by Hotelling's T(2) and Q-residuals statistics for outlier identification - inside/outside the defined space - in order to select objectively the factors to be used in calibration set construction. The results obtained confirm the efficacy of the proposed methodology for stepwise pharmaceutical quality control, and the relevance of the study as a guideline for the implementation of this easy and fast methodology in the pharma industry.

A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas: The PERSEUS experience.

PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD). A complementary approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also independently performed. The comparison between meta-analysis results and IAs shows similarities for coastal areas only. Major knowledge gaps have been detected for the biodiversity, marine food web, marine litter and underwater noise descriptors. The meta-analysis also allowed the identification of additional research themes targeting research topics that are requested to the achievement of GES.

Evaluation and selection of indicators for land degradation and desertification monitoring: methodological approach.

An approach to derive relationships for defining land degradation and desertification risk and developing appropriate tools for assessing the effectiveness of the various land management practices using indicators is presented in the present paper. In order to investigate which indicators are most effective in assessing the level of desertification risk, a total of 70 candidate indicators was selected providing information for the biophysical environment, socio-economic conditions, and land management characteristics. The indicators were defined in 1,672 field sites located in 17 study areas in the Mediterranean region, Eastern Europe, Latin America, Africa, and Asia. Based on an existing geo-referenced database, classes were designated for each indicator and a sensitivity score to desertification was assigned to each class based on existing research. The obtained data were analyzed for the various processes of land degradation at farm level. The derived methodology was assessed using independent indicators, such as the measured soil erosion rate, and the organic matter content of the soil. Based on regression analyses, the collected indicator set can be reduced to a number of effective indicators ranging from 8 to 17 in the various processes of land degradation. Among the most important indicators identified as affecting land degradation and desertification risk were rain seasonality, slope gradient, plant cover, rate of land abandonment, land-use intensity, and the level of policy implementation.

Evaluation and selection of indicators for land degradation and desertification monitoring: types of degradation, causes, and implications for management.

Indicator-based approaches are often used to monitor land degradation and desertification from the global to the very local scale. However, there is still little agreement on which indicators may best reflect both status and trends of these phenomena. In this study, various processes of land degradation and desertification have been analyzed in 17 study sites around the world using a wide set of biophysical and socioeconomic indicators. The database described earlier in this issue by Kosmas and others (Environ Manage, 2013) for defining desertification risk was further analyzed to define the most important indicators related to the following degradation processes: water erosion in various land uses, tillage erosion, soil salinization, water stress, forest fires, and overgrazing. A correlation analysis was applied to the selected indicators in order to identify the most important variables contributing to each land degradation process. The analysis indicates that the most important indicators are: (i) rain seasonality affecting water erosion, water stress, and forest fires, (ii) slope gradient affecting water erosion, tillage erosion and water stress, and (iii) water scarcity soil salinization, water stress, and forest fires. Implementation of existing regulations or policies concerned with resources development and environmental sustainability was identified as the most important indicator of land protection.

Ion mobility spectrometry for the simultaneous determination of diacetyl midecamycin and detergents in cleaning validation.

In the present paper, we have developed two different approaches based on ion mobility spectrometry (IMS) for the cleaning validation of diacetyl midecamycin in the surfaces of manufacture equipment: a semi-quantitative approach based on the use of a sample wand and a quantitative procedure based on the swab test. The simultaneous determination of the active pharmaceutical ingredient and cleaning agents has been performed without important effects of ionization suppression upon the analysis of swabs containing multiple components. Sensitivity, in the ng range, and appropriate selectivity ratify IMS as a serious alternative, a fast and serious alternative in cleaning validation. Other advantage imply its potential for at-line use to perform a semi-quantitative procedure using a sample wand which allows Teflon membranes, swabbed onto the stainless steel surfaces, to be introduced directly into the instrument with no dilution or extraction.

Características clínicas de la degeneración vítreo-retiniana de Goldmann-Favre / Clinical features of Goldmann-Favre vitreoretinal degeneration

Caso clínico: Se presenta el caso clínico de una mujer de 39 años con una degeneración vítreo-retiniana de Goldmann-Favre. La paciente mostraba una disminución de la agudeza visual con nictalopía, retinosquisis foveal y periférica, velos vítreos, degeneración retiniana con acúmulos de pigmento, y un electrorretinograma anormal. Discusión: La paciente presentaba la mayoría de los hallazgos clínicos descritos, con evidentes vasos dendritiformes en la retina periférica(AU)

Case report: We present the case of a 39-year-old woman with Goldmann-Favre vitreoretinal degeneration. The patient showed a decrease in visual acuity with nyctalopia, and foveal and peripheral retinoschisis, vitreal veils, retinal degeneration with clumped pigment, and an unusual electroretinogram. Discussion: Our patient had most of the reported clinical features, with dendritic vessels of peripheral retina(AU)

[Clinical features of Goldmann-Favre vitreoretinal degeneration]. / Características clínicas de la degeneración vítreo-retiniana de Goldmann-Favre.

CASE REPORT: We present the case of a 39-year-old woman with Goldmann-Favre vitreoretinal degeneration. The patient showed a decrease in visual acuity with nyctalopia, and foveal and peripheral retinoschisis, vitreal veils, retinal degeneration with clumped pigment, and an unusual electroretinogram. DISCUSSION: Our patient had most of the reported clinical features, with dendritic vessels of peripheral retina.

[Functional assessment of the different types of anterior cruciate ligament plasty used at the Xoco General Hospital Arthroscopy Service]. / Valoración funcional de los diferentes tipos de plastía del ligamento cruzado anterior empleados en el Servicio de Artroscopía del Hospital General Xoco.

INTRODUCTION: Currently, anterior cruciate ligament lesions have an increased frequency; their management is predominantly surgical; there are several functional assessment systems. MATERIAL AND METHODS: We used the IKDC (International Knee Documentation Committee) functional assessment in patients who underwent anterior cruciate ligament reconstruction at the Xoco Hospital Arthroscopy Service. RESULTS: A total of 73 patients underwent functional assessment; 43 underwent bone-tendon-bone (BTB) repair with patellar tendon graft and 30 underwent repair with pes anserinus tendon graft (T4). In the former group 39 patients had favorable results and 4 unfavorable results; in the latter group 27 patients had favorable results and 3 unfavorable results. DISCUSSION: The results found do not differ significantly between both groups, something that is in agreement with the reviewed literature. The study should be continued with a larger sample size to eliminate variables and obtain more reliable results.

Numerical analysis of cumulative impact of phytoplankton photoresponses to light variation on carbon assimilation.

Light variation in temporal and spatial domains is a key constraint on the photosynthetic performance of phytoplankton. The most obvious responses are the modification of cell pigment content either to improve photocapture or to mitigate photo-damage. Very few studies have analyzed whether light variation significantly alters carbon assimilation, especially in a fluctuating light environment as in the mixed layer of the ocean. We addressed the question using a modeling approach, which allows the reproduction of most of the possible scenarios, obtained with great difficulty from laboratory or field experiments. The complete model is based on the dynamic coupling of a photoacclimation and photodamage-repair responses. In this combined model the virtual phytoplankton is exposed to different light regimes (steady, square wave, sinusoidal light-dark cycles and fluctuating regimes). The results reconcile controversial results on different photoacclimation states achieved during fluctuating light regimes. The model produces a depression of carbon assimilation in any light fluctuating scenario, as compared to steady light regimes, due to the temporal delay between light fluctuations and photoresponses. These results suggest the possibility of selective pressure during evolution, more effective on photoprotective mechanisms than on optimization of light harvesting.

API determination by NIR spectroscopy across pharmaceutical production process.

The purpose of this research was to demonstrate the ability of reflectance near-infrared (NIR) spectroscopy for quantitative analysis of an active ingredient in different production steps of a solid formulation. The drug is quantified at two different steps of a pharmaceutical process: after granulation and after tablet coating. Calibration samples were prepared by mixing pure drug, excipients, and batch samples (75-120 mg/g active ingredient) using a simple methodology that can be easily carried out in a laboratory. Partial least squares calibration models were calculated in second-derivative mode using the wavelength range 1,134-1,798 nm. The error of prediction for granulated samples was 1.01% and 1.63% for tablets. The results prove that NIR spectroscopy is a good alternative to other, more time-consuming means of analysis for pharmaceutical process monitoring.

[Dementia in nonagenarians. Systematic review of population-based studies with Spanish data]. / Demencia en nonagenarios. Revisión sistemáticade estudios poblacionales con datos de España.

INTRODUCTION: Ageing is associated with the quasi exponential getting up of dementia prevalence and incidence until 85 years, but the data in the oldest-old are controversial. AIM. Systematic review of population based studies that analyze prevalence and incidence of dementia in the oldest-old, specifically in nonagenarians. PATIENTS AND METHODS: Systematic review in Medline database of population based surveys describing prevalence or incidence in older than 90, published from 1989. 459 papers were identified, but of the 170 population-based detailed reviewed, 41 studies accomplished the inclusion criteria (Pamplona, Gerona and NEDICES Study are included). RESULTS: The dementia prevalence described in nonagenarians has a range of 25-54%. The dementia incidence in older than 90 has a range of 47-174 cases per 1,000 people/year, being greater in females. In the oldest-old a variable prevalence and incidence of dementia was described in the selected studies. Some authors consider that exist an exponential increase in the dementia prevalence and another ones indicate a slowing of growth in nonagenarians. CONCLUSIONS: This review is concordant with a persistent not exponential increase in prevalence and incidence of dementia in nonagenarians.

Demencia en nonagenarios. Revisión sistemática de estudios poblacionales con datos de España / Dementia in nonagenarians. Systematic review of population-based studies with spanish data

Introducción. El envejecimiento se asocia con un aumento casi exponencial en la prevalencia e incidencia de la demencia hasta los 85 años, pero los datos en los ‘muy ancianos’ son controvertidos. Objetivo. Revisión sistematizada de estudiospoblacionales sobre prevalencia e incidencia de la demencia en los ‘muy ancianos’, y específicamente en nonagenarios.Pacientes y métodos. Revisión sistemática en Medline de estudios poblacionales sobre prevalencia e incidencia de la demencia, con descripción de casos de nonagenarios publicados desde 1989. De 459 publicaciones descritas, se analizaron 170 estudios poblacionales, y se seleccionaron 41 que cumplían los criterios de inclusión (se incluyen los estudios españoles de Pamplona, Gerona y NEDICES).Resultados. La prevalencia de la demencia en nonagenarios oscila entre el 25-54%, y la incidenciaentre 47-174 casos por 1.000 personas/año, y es mayor en las mujeres. Los estudios seleccionados muestran gran variabilidad en la prevalencia e incidencia de la demencia en los muy ancianos. Algunos autores consideran que en este grupo de edad sigue existiendo un incremento exponencial de casos de demencia, y otros describen un enlentecimiento de este incremento.Conclusión. En los nonagenarios se produce un incremento no exponencial en la prevalencia e incidencia de la demencia

Introduction. Ageing is associated with the quasi exponential getting up of dementia prevalence and incidence until 85 years, but the data in the oldest-old are controversial. Aim. Systematic review of population based studies that analyze prevalence and incidence of dementia in the oldest-old, specifically in nonagenarians. Patients and methods. Systematic review in Medline database of population based surveys describing prevalence or incidence in older than 90, published from1989. 459 papers were identified, but of the 170 population-based detailed reviewed, 41 studies accomplished the inclusion criteria (Pamplona, Gerona and NEDICES Study are included). Results. The dementia prevalence described in nonagenarians has a range of 25-54%. The dementia incidence in older than 90 has a range of 47-174 cases per 1,000 people/year, being greater in females. In the oldest-old a variable prevalence and incidence of dementia was described in the selected studies.Some authors consider that exist an exponential increase in the dementia prevalence and another ones indicate a slowing of growth in nonagenarians. Conclusions. This review is concordant with a persistent not exponential increase in prevalence andincidence of dementia in nonagenarians